Abstract
BackgroundEnsuring equitable and timely access to Cognitive Behaviour Therapy (CBT) is challenging within Canada’s service delivery model. The current study aims to determine acceptability and effectiveness of 4-session, large, Cognitive Behaviour Therapy with Mindfulness (CBTm) classes.MethodsA retrospective chart review of adult outpatients (n = 523) who attended CBTm classes from 2015 to 2016. Classes were administered in a tertiary mental health clinic in Winnipeg, Canada and averaged 24 clients per session. Primary outcomes were (a) acceptability of the classes and retention rates and (b) changes in anxiety and depressive symptoms using Generalized Anxiety Disorder 7-item (GAD-7) and Patient Health Questionnaire 9-item (PHQ-9) scales.ResultsClients found classes useful and > 90% expressed a desire to attend future sessions. The dropout rate was 37.5%. A mixed-effects linear regression demonstrated classes improved anxiety symptoms (GAD-7 score change per class = − 0.52 [95%CI, − 0.74 to − 0.30], P < 0.001) and depressive symptoms (PHQ-9 score change per class = − 0.65 [95%CI, − 0.89 to − 0.40], P < 0.001). Secondary analysis found reduction in scores between baseline and follow-up to be 2.40 and 1.98 for the GAD-7 and PHQ-9, respectively. Effect sizes were small for all analyses.ConclusionsThis study offers preliminary evidence suggesting CBTm classes are an acceptable strategy to facilitate access and to engage and maintain clients’ interest in pursuing CBT. Clients attending CBTm classes experienced improvements in anxiety and depressive symptoms. Symptom improvement was not clinically significant. Study limitations, such as a lack of control group, should be addressed in future research.
Highlights
Ensuring equitable and timely access to Cognitive Behaviour Therapy (CBT) is challenging within Canada’s service delivery model
Sociodemographic factors and dropout Of the 655 clients assessed for eligibility for the Cognitive Behaviour Therapy with Mindfulness (CBTm) classes from November 2014 to December 2016, 533 attended at least one class (10 of these clients did not fill out any measures and were not included in analysis)
The mixed-effects linear regression indicated a statistically significant decline in symptoms of anxiety when attending CBTm classes
Summary
Ensuring equitable and timely access to Cognitive Behaviour Therapy (CBT) is challenging within Canada’s service delivery model. It is estimated up to 3.5 million Canadians will access health services for a primary mood or anxiety disorder [1], and individuals with an anxiety disorder are known to be at an increased risk of developing a comorbid major depressive disorder [2] These mental health conditions are associated with general medical conditions [3, 4], poor psychosocial functioning [5, 6], and poor occupational functioning [7, 8], leading to significant burden on CBT is administered in diverse settings by a variety of health care practitioners including general practice physicians, psychiatrists, psychologists, nurses, and occupational therapists. Administering CBT in a large-group is a promising solution which enables clinicians to reach a large number of clients
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